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World Health Organization
WASMUN 2003
Topic A: Mental Health
Topic B: Childhood Vaccines
Dear Delegates,
Hello and welcome to the Word Health Organization of Washington State Model
United Nations 2003. I am excited and honored to be directing this committee, and I am
eager to meet you. This year we will be addressing two very important concerns in the
world today – the lack of adequate mental health care and the need to increase childhood
immunization rates worldwide.
In selecting this year’s topics, we tried to find subjects that would cover a wide
range of related health and public policy issues that are not often discussed or not
generally well understood. For example, mental health is related to illnesses that are not
viewed the same as infectious diseases and are often not identified until it is too late. On
the other hand, childhood vaccination touches on the issue of prevention, a part of health
care that is important, but often neglected.
As you read through this study guide, I hope that you will find some aspects of
the topics that will interest and encourage you to become passionate about the World
Health Organization and the United Nations. The productivity and energy level of our
committee depends on your efforts, and I know that you will make our committee the
most exciting and interesting of this year’s conference. I would like to thank you in
advance for all of your hard work and dedication. I guarantee that you will enjoy this
conference, and I look forward to meeting you in April.
Sincerely,
James Ham
Chair, World Health Organization
[email protected]
360-789-3924
HISTORY OF THE COMMITTEE
International cooperation in health initiatives can be traced back 150 years to the
first International Sanitary Conference of 1851, whose purpose was to discuss the spread
of plague in Europe. In 1902, the first permanent entity to address the goal of improving
global health, the International Sanitary Bureau, was established in Washington, D.C.,
and was later renamed the Pan American Health Organization, and is still an active
component of WHO today. Other similar landmark steps, such as the creation of the
Office International d’Hygiene Publique in 1907 and the Health Organization of the
League of Nations in 1919, paved the way toward the establishment in 1948 of a
permanent, autonomous entity to “promote and protect the health of all peoples”, the
World Health Organization.
Formally, WHO is a specialized agency existing within the charter of the United
Nations with the main objective of “attainment by all peoples of the highest possible level
of health.” In its official philosophy, the organization emphasizes that a healthy person is
not only free of disease but also is in a state of “complete physical, mental, and social
well-being”. In order to meet such a goal as defined, WHO serves as a mediator, which
can often collaborate with governments and non-governmental organizations (NGOs) to
administer and develop local, national and international health programs. It is also
actively involved in the creation and distribution of new technologies, both directly and
indirectly related to health care.
Given the prevalence of life-threatening disease, achieving the long-term goals of
WHO requires a significant degree of decentralization. Accordingly, there are six
regional offices of WHO responsible for their own geographical areas. These coordinate
with the three main components of WHO, the World Health Assembly, the Executive
Board, and the Secretariat, to establish and maintain their international initiatives.
Today, despite its impressive history of improving world health, WHO still has
many problems that it must face. Recent WHO events focused on mental health as one of
the world’s most pressing concerns. Other problems such as the eradication of polio also
remain unsolved, despite numerous expenses and efforts. It is therefore largely up to the
member states to contribute actively to discussion and to compromise in order for the
organization to progress toward resolving these difficult questions.
TOPIC A: MENTAL HEALTH
STATEMENT OF THE PROBLEM
The prevalence of the global mental health crisis cannot be ignored. The
importance of mental health in mainstream medical care is unfortunately, often
underestimated. Nevertheless, a large proportion of debilitating illness worldwide can be
categorized as mental health problems. Many of them striking with no discrimination to
age, gender, or socioeconomic status, mental illnesses represent a problem, which faces a
significant percentage of the world’s population. Yet these diseases often have simple,
developed treatments which are not applied due to social stigma, absence of accessible
resources, and misdiagnosis.
Additionally, ignorance about these psychological ailments contributes to the
victims’ tendencies to not seek out help due to a lack of general awareness. Some UN
member states do not even have mental health programs. Nevertheless, mental diseases
are real, even if their outward appearances are not always so obvious. As expressed by a
recent statement from WHO: “The existence of mental and brain disorders often remains
hidden… Yet the underlying abnormal substructure of many disorders has been identified
by images of the brain. Thus to ignore their existence is akin to denying that cancer
exists because we are unable to see the abnormal cells without a microscope.” All too
often, mental disease also contributes to early death, often through seemingly unrelated
causes such as heart disease, according to a June 2001 study by the United States
Department of Health. In some cases, patients wrestle with such painful disorders that
they even choose death as a form of relief from their suffering. It is evident that there are
formidable obstacles to combating mental illnesses. However, we have come a long way
since the last century and improving upon treatment programs is a very feasible task.
HISTORY OF THE PROBLEM
The history of treating mental illness is one of vast improvement. One hundred
years ago, common treatments for schizophrenia included drilling holes into the patient’s
head and “beating the devil” out of the victim. Even worse, the famous St. Mary of
Bethlehem Hospital in London, more commonly known as Bedlam, entertained visitors
who would pay money to see patients in a matter similar to a freak show. What is now
know as psychiatry did not emerge until the late 19th century, largely due to the efforts of
French physician Philippe Pinel who advocated mental hospitals with more scientific
approaches to treatment. Gradually, new methods of treatment emerged, ranging from
biomedical therapies to Freudian psychotherapy to humanistic approaches. By the
1950’s, community-based treatment programs, with more individual attention being their
greatest advantage, became extremely popular in North America and Europe and
displaced many mental health hospitals. Many of these large institutions were disbanded
due to human rights violations. However, in most parts of the world, even today, these
facilities still exist in great numbers.
BLOC POSITIONS
Central and South America
Countries in this bloc are generally not engaged in active research for new
treatment methods. However, in several states, most notably Brazil, many consumer
lobbyists have been successful in their de-institutionalization efforts. Past experiences of
war and displaced persons for many nations in this bloc, have increased the need to place
emphasis on mental health awareness.
Western Bloc (Excluding Europe)
Typically, the nations of the Western Bloc engage in a great deal of health
research. However, it is not always the best way of solving mental health problems, since
solutions are usually simply found in improving access to already existing treatment.
Members of this bloc will promote community-based care and will push for drafting
WHO recommendations that involve extensive facilities and resources to benefit nations
in this bloc.
African Bloc
The most important concern by far for the African nations is the mental health of
refugees. Many of the countries of the bloc have been in a state of war and insurrection
which have resulted in large numbers of displaced persons and survivors of traumatic
situations.
Europe and Russia
The trend of de-institutionalization in this bloc has been established since the
1970’s. Community-based care has been a trend that will continue to grow as European
nations disband existing large mental hospitals. Heavy emphasis is also placed on
rehabilitation and the ability of patients to eventually return to society and lead normal,
production lives. These nations will most likely seek the most economical methods of
establishing local community mental health programs and raising general awareness
about the problem.
Southern and Eastern Asian Nations
The biggest problem facing these member states is the stigma and discrimination
associated with mental patients. This aspect of society makes it extremely difficult for
governments to establish better programs, as afflicted individuals are hesitant to seek
treatment. Furthermore, rehabilitated individuals who return to normal society are
labeled and subject to discrimination. As a result the Asian nations will focus their
efforts on education and awareness activities and seek WHO involvement to provide
resources and campaigns.
Middle Eastern Bloc
Several countries in the Middle East have been successful in integrating mental
health into primary care programs. As a result many community care facilities exist in
nations such as Iran. However, there is still much room for improvement. Rural areas,
for example, often do not receive adequate resources, and discrimination and stigma
issues remain unresolved. Thus, nations from this bloc will promote education and
awareness actions while continuing to incorporation mental health into general health
care.
PAST UN ACTION
As early as 1959, when WHO decided on mental health for its World Health Day
theme, experts recognized the importance of the issue. Many of the same problems were
addressed – treatment options, stigma, and burden on society. Today, while major
advances have been made in terms of medications and treatment methods, accessibility to
these resources is still greatly limited.
The fundamental ideas for the current campaign for mental health were laid down
in 1991 when the UN General Assembly (GA) adopted resolution A/RES/46/119, “The
Principle for the Protection of Persons with Mental Illnesses and for the Improvement of
Mental Health Care.” This landmark declaration outlined the basic rights of the mentally
disabled and condemned the discrimination and lack of care that often accompanies their
ailments.
One of the most prominent ideas to solve the mental health crisis came out of
discussion held at the Geneva World Health Assembly meeting in April 1999. In this
meeting, experts from around the world discussed WHO’s potential collaboration with
local science industries and institutions and non-governmental organizations (NGOs) –
resulting in the establishment of WHO Collaborating Centers. These centers serve not
only to promote awareness in mental health, but also to make significant advances in the
field.
Alongside its efforts to establish collaboration, recently, over the course of 2001,
WHO has stepped up its mental health education campaign. For example in April 2001,
WHO launched Project ATLAS, which is an ongoing survey effort to assess mental
health programs worldwide. The results of this initiative as well as others, including the
discussion of the 54th WHA in May 2001, were published in the World Health Report
2001 entitled “Mental Health: New Understanding, New Hope.”
PROPOSED SOLUTIONS
Solving the problem of mental health is a complex question, but essentially can
been broken down into its components: fighting discrimination and raising awareness,
improving health care programs through de-institutionalization and other means, and
finally creating legislation to address the mental health of refugees and those in crisis
situations.
Mental health remains a topic often ignored by many countries, particularly lesser
developed nations in the UN, 30 percent of which do not even have basic mental health
care programs. Illnesses such as schizophrenia, depression, epilepsy, and alcohol
dependence are, nevertheless, prevalent diseases, which are becoming increasingly
common. Indeed, the World Health Organization (WHO) estimates that by the year
2020, such disorders will be responsible for 15% of DALY’s (disability adjusted life
years) lost.
As the global leader in health policy, WHO can make valuable recommendations
and establish guidelines for countries that seek to improve their mental health programs.
Our committee will then have to decide how best to approach the lack of attention to
mental health worldwide. Is education the key? Or should we focus on deinstitutionalization and more individualized care? On the other hand, the issue of
available resources is also an important one, as developing nations often cannot afford to
implement many of the recommendations deemed necessary for an effective mental
health program. Are there ways to overcome this obstacle? By what means? Should
governments be responsible for providing mental health care programs? How should
NGO’s be facilitated and solicited? By formulating carefully planned and executable
guidelines, which answer these questions, WHO can play an important role in resolving
the mental health problem.
TOPIC B: CHILDHOOD VACCINES
STATEMENT OF THE PROBLEM
Today, researchers continue to develop newer and better vaccines to protect us
from progressively more dangerous infectious diseases. This ability to safeguard
ourselves against “invisible killers” has proven to be one of the most promising and
miraculous advancements in medicine. Undoubtedly, the practice of immunization has
allowed millions of people of the past few decades to escape the terrible wrath of
diphtheria, polio, measles, smallpox – just a few of the enemies which modern medicine
has learned to combat. And although we now have the power to prevent these diseases
from ever striking again, there are still many obstacles that stand in the way.
It has been two hundred years since doctors first discovered the process of
immunization, yet some two million children still die each year from illnesses for which
we have established vaccines. Hepatitis B, for example, is alarmingly prevalent in
countries such as Benin and Cambodia, yet these countries cannot afford the US $1 per
dose price tag that comes with lifelong protection against the disease. The fact that we
have the ability to stop this suffering is one of the greatest tragedies of our generation.
One quarter of the world’s children are not immunized. Every ten seconds a
person somewhere in the world dies of a preventable disease. Solving the vaccination
problem is not easy, as its roots span and intertwine across a multitude of disparate areas.
Financial problems, delivery and service issues, and unchanging attitudes of governments
are but a few of the points that our committee must address. Discussion and debate
around these key issues will be instrumental in devising a comprehensive resolution.
HISTORY OF THE PROBLEM
In the late 1700’s, Edward Jenner’s discovery of the small pox vaccine sparked a
flurry of scientific advancement leading to the age of immunization. The basic concept
behind vaccination is this: by exposing the body to a weakened form of some pathogen
such as an attenuated or sometimes even dead virus, a person’s natural immune response
develops antibodies to counter the foreign agent. Since the pathogen is weakened, the
immune system overcomes the outside threat but is subsequently prepared for any attack
by the real virus.
In the early 20th century, use of vaccines was relatively haphazard and confined to
local areas. Local outbreaks would be controlled, but since no consistent global or even
national policies existed, the disease would still appear at various unpredictable times and
places. By this time, most of the industrialized countries had in their possession vaccines
against smallpox, tuberculosis, yellow fever, and a host of others. Some of these, such as
the smallpox vaccine, were highly effective, while others had limited protective ability.
Nonetheless, through child health services and efforts to increase coverage, more and
more people were being protected from these historic scourges. It is important to note,
however, that in the first half of the 20th century, there was no concerted effort in any
nation to immunize all of its citizens.
During the 1950’s, however, the increased number of vaccines available and their
increased effectiveness prompted many officials worldwide to begin considering
complete global immunization resulting in eradication of certain diseases. Development
of the Oral Polio Vaccine (OPV), which could easily be administered, further
demonstrated that lifelong protection was, in practical terms, not difficult to achieve on a
large scale –even syringes and needles were not required in some cases.
In 1956, WHO took the next logical step and decided to begin its war on disease
by selecting smallpox as “global enemy number one.” The intensive immunization
program which followed was successful beyond expectation. Only twelve years after the
first vaccinations in 1967, WHO declared total victory over smallpox – the last man to be
naturally infected with the disease, a Somalian cook, was infected in 1977 and survived.
Unfortunately, the victory over smallpox has been the only one that any
organization has achieved. Actually reaching out to those in high-risk areas is the hardest
part, since we have vaccines for many killer illnesses. Today, most immunization efforts
center on the “big six” six common infectious diseases for which we have developed
vaccines. These preventable diseases are: measles, tetanus, pertussis (whooping cough),
tuberculosis, polio, and diphtheria.
The most pressing issues concerning vaccination deal with access and delivery.
Many times, vaccine stocks are spoiled as a result of inadequate infrastructure to store
and maintain their efficacy. Usually, vaccines are delivered by airplane, stored in cold
rooms and refrigerators until administrators can allocate them to various clinics and the
field. Along this “cold chain” is where many flaws exist, resulting in incomplete or
improper vaccination.
Many lesser developed nations requiring vaccines also possess little or no health
infrastructure or central authority to govern the supply and delivery of vaccines. The
common problems that accompany weak health infrastructures are insufficient
refrigeration, lack of delivery vehicles, and lack of trained health staff. Unstable
infrastructure often results in inefficient dissemination of critical information and
resources. In fact, a WHO study reported that 43% of vaccines delivered to lesser
developed nations are actually wasted for these reasons.
BLOC POSITIONS
Central and Sub-Saharan Africa
The nations in this region will benefit most from outside assistance. Many the
critical infrastructure required to implement large-scale immunization programs, although
in the past thirty years there has been a dramatic improvement in childhood immunization
rates. Typically, many of the countries in this region are also involved in war or
insurrection. As a result, these states generally do not have the resources or the personnel
and will subsequently call for educational and training programs alongside its requests for
supplies and equipment.
Countries of the Former Soviet Union
Having recently suffered from the diphtheria epidemic, these nations know from
experience the consequences of lacking immunization schedules. These countries will
therefore be strong advocates of sustainability with an emphasis on commitment. They
will likely support resolutions with a focus on awareness programs and education
stressing the importance of commitment from industrialized nations.
Western Bloc (Excluding the Former Soviet Union Countries)
These nations will feel secure having well-established immunization programs.
In fact, other countries will look towards this bloc for assistance and guidance as to how
to form their own programs. Nonetheless, no nation is safe from infectious disease. And
with the emerged threat of bioterrorism, the members of this bloc must also address
vaccination strategies and re-examine their current infrastructure. Thus, the countries of
this bloc will advocate assistance and aid, with a focus on pharmaceutical companies
which are based in this region. They will work towards subsidizing prices for existing
vaccines and encourage companies to do more research on new vaccines. At the same
time, however, this bloc does not want developing nations to become dependent on their
aid for an indefinite period of time, and will therefore emphasize the importance of longterm sustainability.
Central and South American Bloc
Although vaccination programs are not as well-established as those found in
North America and Europe, they do exist and have prevented outbreaks over the course
of the previous decade. Nevertheless, the nations of this bloc will not be anxious to be
the source of aid, as they must first improve up on their own health programs and
infrastructure. Thus, these countries will take a more neutral approach in advocating aid
in the short-term from WHO and will support resolutions stressing sustainability.
Northern African, Southeast Asian, Middle Eastern Bloc
Although they have higher immunization rates than their Southern and SubSaharan counterpart, these nations still require a great deal of assistance in infrastructure
and health programs. As a result, these countries will advocate aid and educational
programs, preferably sponsored by an international organization such as WHO.
East Asian Bloc
While the countries in this bloc usually have effective immunization programs,
the biggest concern for the nations here is accessibility and delivery to rural areas. These
countries will likely support resolutions that address the issue of improving immunization
programs to include and sustain rural areas.
PAST UN ACTIONS
Encouraged by the success if its smallpox eradication campaign, WHO began to
look towards other projects. In 1974, the Expanded Program on Immunization (EPI),
which included protection against tuberculosis, polio, measles, pertussis, diphtheria, and
tetanus, was launched. At this time, only 5% of children in the developing world were
immunized against these “big six” diseases. In the years that followed, WHO, UNICEF,
and other groups put together a large-scale immunization campaign, which included
training, information dissemination, and infrastructure reform. By 1984, immunization
coverage rates had risen dramatically. Average DPT (Diphtheria, Pertussis, Tetanus) and
measles coverage, for example, went from 25 to 40 percent; polio protection went up by
70%.
WHO has also devoted some efforts to training programs designed to accompany
the EPI. The Global Training Network on Vaccine Quality (GTN), for example, was
established in 1996 as the answer to lack of qualified health workers in developing
countries. The network has 12 centers worldwide and offers a number of training
courses, each with accompanying documentation and certification. Workshops also
complement normal curricula, which are available through application on a case-by-case
basis.
In May 1988, WHO embarked on another ambitious journey: the eradication of
polio. Acting in accordance with the WHA resolution to destroy polio by the year 2000,
(which has now been expanded to 2005), WHO designed and executed a four-pronged
approach modeled after the previously successful smallpox campaign. This included
routine immunization, national immunization days, door-to-door vaccinations, and
surveillance. Eradication efforts today are still based on this model. WHO estimates that
the campaign is 99% complete, but funding (mostly delivery costs) and commitment
problems pose challenging obstacles to the final goal.
PROPOSED SOLUTIONS
The solution to eliminating many diseases lies not in curing them after the fact,
but in preventative measures, such as ensuring sanitary environments and providing
vaccinations. Currently there exist preventative cures for countless diseases such as
polio, diphtheria, and measles, yet people – mostly children – still die needlessly from
these ailments. The problem is not so much the result of an inability to synthesize the
materials needed, but rather a consequence of distribution issues, inadequate funding, and
lack of political commitment. In particular, it is exceedingly difficult to get even basic
vaccinations into rural, sparsely populated regions of the world. A lack of trained health
staff in certain areas also contributes to the problem; as stated earlier, 43% of vaccines
delivered to developing countries are spoiled due to improper storage practices.
An effective resolution for this topic must address all of the key components of
the immunization problem: delivery and accessibility, commitment, and funding. Each of
these main components encompasses a multitude of details and smaller problems which
have to be addressed if we are to achieve global immunization.
How can we ensure that national governments have an adequate supply of
vaccines? If the vaccines are available, then how can we strengthen local infrastructure
so that timely delivery of the vaccines is possible and the “cold chain” is maintained?
Furthermore, how can sustainability be achieved? Can we find a way for countries to
sustain their own immunization programs independently? Can national governments
continue to rely on international organizations such as WHO indefinitely – or, more
importantly, what happens if nations do not seek out assistance at all? How can global
immunization be achieved in these cases? Should NGO’s such as the Global Alliance for
Vaccination and Immunization (GAVI) be used to intervene when national governments
fail to establish their own local programs?
Our committee will have to debate these important concerns, keeping in mind the
issue of sustainability, since member states cannot be dependent on outside resources
indefinitely. Furthermore, we must also deal with financial constraints and cultural
solidarity issues as we pursue resolutions. Only through thoughtful discussion of these
key issues can WHO hope to save lives otherwise lost to preventable diseases.
CLOSING REMARKS
Although this is the end of my story, it is only the starting point for your research
and model UN experience. I urge you to expand on these issues and investigate the topic
areas on your own. Each is extremely broad, and you will at times feel overwhelmed
with information. However, use this to your advantage and be sure to take note of
interesting and new information that I have not covered in this study guide. I hope that
you will find your research experience fun and enjoyable. I encourage you to contact us
with any questions or concerns.
On behalf of the executive team of WHO of WASMUN 2003, I wish you the best
of luck in your research, and I look forward to seeing you in April.
BIBLIOGRAPHY OF SELECTED SOURCES
World Health Organization Home Page. <http://www.who.int>.
TOPIC A: MENTAL HEALTH
Mental Help Net Web Page. CMHC Systems. <http://mentalhelp.net>.
“Mentally Ill Denied New Medication.” The London Times. 9 Jul 2001.
Myers, David G. Psychology. 5th ed. New York: Worth, 1998.
Thompson, Ginger. “Up From Bedlam: New Model for the Mentally Ill.”
The New York Times. 11 May 2001, Late ed: A4.
Vanguard. “Nigeria at the Borders of Lunacy.” Africa News. 17 Apr 2001.
WHO/FS/219. “Strengthening Community Mental Health Services and Primary Care.”
WHO Fact Sheet, April 1999. <http://www.who.int/inf-fs/en/fact219.html>.
WHO/FS/260. “Mental Health Resources in the World.” WHO Fact Sheet, April 2001.
<http://www.who.int/inf-fs/en/fact260.html>.
WHO/PR/01. “WHO Launches Mental Health 2001 Campaign.” WHO Press Release,
January 10, 2001. <http://www.who.int/inf-pr-2001/en/pr2001-01.html>.
WHO/PR/18. “As Burden of Mental Disorders Looms Large, Countries Report Lack of
Mental Health Programmes.” WHO Press Release, April 6, 2001.
<http://www.who.int/inf-pr-2001/en/pr2001-18.html>.
World Health Organization Mental Health Home Page. World Health Organization.
<http://www.who.int/mental_health/index.html>.
World Health Organization. “Stop Exclusion, Dare to Care: Mental Health Around the
World.” Geneva: WHO Dept of Mental Health and Substance Dependence, 2000.
TOPIC B: CHILDHOOD VACCINES
Bellamy, Carol. “Reaching Every Child On Earth.” UNICEF Pamphlet.
<http://www.childrensvaccine.org/html/gavi-ark.htm#materials>.
“Diphtheria, Thought Eradicated, Reappears in Eastern Europe and Asia.”
Agence France Presse. June 19, 1995.
“Disease Information: Diseases Preventable By Traditional Vaccines.”
Global Alliance for Vaccines and Immunization Homepage.
<http://www.vaccinealliance.org/disease/tradvacc.html>.
Henderson, Donald A. “The Eradication of Smallpox.” Microorganisms:
From Smallpox to Lyme Disease. Thomas D. Brock, Ed. New York:
W.H. Freeman, 1990.
“History of Immunization.” WHO Dept of Vaccines, Immunization and Biologicals
Home Page. <http://www.who.int/vaccines-diseases/history/history.htm>.
Msambichaka, Khadija Ali. “Sustaing Immunisation Efforts Under Health Reform:
Challenges for Africa.” 1999. Bill and Melinda Gates Children’s Vaccine
Program Homepage. <http://www.childrensvaccine.org/files/msama_hlth.pdf>.
“Polio Eradication.” Polio Eradication Home Page. <http://www.polioeradication.org>.